Alleged medical abandonment in chronic opioid analgesic therapy: case report

Pain Med. 2009 May-Jun;10(4):722-9. doi: 10.1111/j.1526-4637.2009.00620.x. Epub 2009 Apr 22.

Abstract

Objectives: The objectives of this medicolegal case report were the following: 1) present details of a chronic pain patient (CPP) on chronic opioid analgesic therapy (COAT), who diverted her opioids and was terminated from treatment, and subsequently committed suicide; 2) present both the plaintiff's and defendant's (the COAT prescriber) expert witnesses' opinions as to the allegation of medical abandonment of this patient and other allegations; and 3) based on these opinions, to develop some recommendations as to how pain physicians can minimize their medicolegal risk when termination of the physician-patient relationship is warranted.

Methods: This is a case report of a CPP treated by a pain physician who demonstrated aberrant drug-related behaviors and required large doses of controlled-release oxycodone.

Results: Differences between the plaintiff's and defendant's experts' opinions are presented by utilizing the COAT literature. Options for avoiding allegations of abandonment are proposed.

Conclusions: To avoid and protect themselves against potential abandonment allegations when termination of the physician-patient relationship is warranted, physicians are advised to consider following the outlined procedures.

Publication types

  • Case Reports

MeSH terms

  • Abdominal Pain / drug therapy
  • Abdominal Pain / etiology
  • Abdominal Pain / physiopathology
  • Adult
  • Alcoholism / complications
  • Alprazolam / administration & dosage
  • Analgesics, Opioid / administration & dosage
  • Analgesics, Opioid / adverse effects*
  • Crime
  • Drug Administration Schedule
  • Fatal Outcome
  • Female
  • Humans
  • Hypnotics and Sedatives / administration & dosage
  • Malpractice / legislation & jurisprudence*
  • Opioid-Related Disorders / etiology
  • Opioid-Related Disorders / psychology
  • Oxycodone / administration & dosage
  • Oxycodone / adverse effects
  • Pain, Intractable / drug therapy*
  • Pain, Intractable / etiology
  • Pain, Intractable / physiopathology
  • Pancreatitis, Chronic / complications
  • Pancreatitis, Chronic / physiopathology
  • Patient Compliance
  • Physician-Patient Relations*
  • Refusal to Treat / ethics
  • Refusal to Treat / legislation & jurisprudence*
  • Self Medication / psychology
  • Suicide / ethics
  • Suicide / legislation & jurisprudence*

Substances

  • Analgesics, Opioid
  • Hypnotics and Sedatives
  • Oxycodone
  • Alprazolam